Healthcare Provider Details

I. General information

NPI: 1316066749
Provider Name (Legal Business Name): PREISZ MCMILLIN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 NW 51ST ST
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

3629 NW 51ST ST
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-4244
  • Fax: 405-601-3750
Mailing address:
  • Phone: 405-848-4244
  • Fax: 405-601-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number132
License Number StateOK

VIII. Authorized Official

Name: DEBRA J PARRISH
Title or Position: OFFICE MGR
Credential:
Phone: 405-601-0954